Gestational diabetes (GDM) is defined as glucose intolerance during pregnancy. During your pregnancy, hormonal changes can cause your body to be less sensitive to the effect of insulin. These changes can lead to high blood sugar and diabetes. High blood sugar levels in pregnancy are dangerous for both mother and baby.

The doctor should consider the possibility of GDM starting at the first prenatal visit. Women who are significantly obese, who have previously had GDM, who have a strong family history of diabetes, or who have some sugar in the urine should have a glucose tolerance test as soon as possible.

Whether or not they were tested earlier in pregnancy, most women should be tested between weeks 24 and 28 of gestation, unless they meet all of the following criteria: They are under 25 years of age, had a normal weight before pregnancy, come from an ethnic group without much diabetes, have no known diabetes in close relatives, have no history of glucose problems, AND have never had a poor obstetric outcome.

If you have gestational diabetes, the steps listed here will help you control the disease:

• Meet with a registered dietitian who is expert in diabetes.
• Learn how to check your blood sugar levels with a glucose meter.
• Check your sugar levels fasting and 1 to 2 hours after each meal.
• Check your urine for ketones to be sure you are getting enough calories and carbohydrates.
• Follow a meal plan that has the right balance of protein, carbohydrates, and fat.
• Eat 5 to 6 smaller meals rather than 2 to 3 larger ones.
• Include a bedtime snack in your meal plan.
• Monitor weight gain, which is a key component of pregnancy care whether you are glucose intolerant or not, but especially important if you are.

Many women are frightened and upset when they learn about their diagnosis. After the initial shock wears off, most report improving their diet and increasing their exercise level.

Some women may need to treat gestational diabetes with insulin to control blood glucose levels and avoid complications for the fetus. Regular ultrasounds, especially early in the third trimester of pregnancy, will help your doctor decide if insulin is necessary. Your doctor or diabetes educator will teach you the required techniques for using insulin and should provide good support.

Gestational diabetes usually disappears with the end of the pregnancy. You should be checked by your doctor 6 to 12 weeks after delivery. However, if you have had gestational diabetes, you are at greater risk for developing diabetes later in your life.